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MEDICAL EDUCATION AND SOC IETAL NEEDS:
A PLANNING REPORT FOR THE HEALTH PROFESSIONS
Report of a study by
a committee of the
INSTITUTE OF MEDICINE
Division of Health Sciences Policy
July 1983
National Academy Press
Washington, D . C .

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NOTICE The project that is the subject of this report was approved by
the Governing Board of the National Research Council, whose members
are drawn from the councils of the National Academy of Sciences, the
National Academy of Engineering, and the Institute of Medicine. The
members of the committee responsible for the report were chosen for
their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors
according to the procedures approved by a Report Review Committee
consisting of members of the National Academy of Sciences, the
National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National
Academy of Sciences to enlist distinguished members of the appropriate
professions in the examination of policy matters pertaining to the
health of the public. In this, the Institute acts under both the
Academy's 1863 Congressional charter responsibility to be an advisor
to the federal government and its own initiative in identifying issues
of medical care, research, and education.
This study was supported by The Pew Memorial Trust.
2101 Constitution Avenue, N.W.
Washington, D.C. 20418
(202) 334-3300
Publication No. IOM-83-02

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CONTENTS
Commi t tee
Study Staff
Pref ace
Acknowledgements
Part I: Introduction and Ma jor Recommendation
. INTRODUCTION
Charge to the Planning Committee
Work of the Planning Committee
Rationale for an Integrated Look at Major Issues
Commit tee Conclusions
Proposed Plan
References
2. LOOKING AHEAI): AN AGENDA GROUP ON EDUCATION OF
HEALTH PROFESSIONALS
Composition and Qualities of the Agenda Group
Activities of the Agenda Group
Sponsorship of the Agenda Group
Financial Support
Implementation of the Agenda Group Recommendations
Summary of the Strategic Approach of the Agenda Group
References
Part Il: Priority Medical Education Issues
3 . IS SUES FOR TARGETED STUDY
Study Issue 1: Financial Pressures on Medical Education
Impact on Students: The Cost of Medical Education
Impact on Students: Availability of Financial Assistance
Impact on Teaching Hospitals and Medical Schools
Study Issue 2: The Changing Role of the Physician
Desired Qualities in Physicians
Health Manpower Policy
Potential New Roles for Physicians
Study Issue 3: The Cultures of the Medical Education System
Decision~aking in the Medical Education System
Faculty Roles: Fostering Teaching, Research and Service
The Professionalization Process for the Physician
The Teaching Hospital
The Premedical Syndrome
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PREFACE
As its charter states, "the Institute of Medicine shall be
concerned with the protection and advancement of the health of the
public," including "education for the health and medical professions
and sciences." Thus, numerous Institute studies during the past
decade have related, directly or indirectly, to diverse aspects of
medical education, the health professions, and health manpower, all in
the context of societal needs. Clearly, medical education has been an
Institute-wide concern and not just the concern of the members in
academic medicine or in academic administration.
The current Institute president, Dr. Frederick C. Robbins,
conceived the idea of a comprehensive review of medical education in a
contemporary setting and was fortunate in finding The Pew Memorial
Trust willing to support such an effort. Given the many studies and
reviews carried out by national commissions and professional medical
associations, it seemed appropriate to proceed in stages. Thus the
task was cast as one of planning whether such a review should be
conducted and, if so, how. ~
As the committee's work progressed, it became increasingly clear
that a ready-made solution to this complex problem was not in the
cards. The consensus at which we finally arrived reflects our
conviction that the task at hand is one that will need continued
attention. Thus it will be required that the health professions learn
to better adapt their educational agendas to continued progress in the
sciences and related technologies as well as to societal needs and
expectations and, last but by no means least, changes in resource
allocations that take only little account of what consequences they
may have for education.
With no illusion that the "problematique" of medical education at
the end of this century could be approached in the manner that had
been so successful when the century was young, the Institute president
assembled a committee from a broad range of disciplines and
professions. Two-thirds of the committee members had gone through the
personal experience of a medical education. Because the chairman
lacked such experience, it was indispensable to have him associated
with a vice-chairman who had practiced medicine and done biomedical
research. Dr. Elena Nightingale, an Institute Senior Scholar in
Residence, was ideally suited to play that role. She and the study
director, Dr. Barbara Filner, set a high standard of thoughtfulness,
flexibility, and hard work, a standard that the entire committee
appreciated and adopted.
Walter A. kosenblith
Chairman
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ACKNOWLEDGEMENTS
It is with pleasure and deep gratitude that we particularly
acknowledge the wise counsel of Or. John k. Evans, Chairman, Allelix
Inc.; Dr. David A. hamburg, President, Carnegie Corporation of hew
York; Dr. Julius B. Richmond, Professor of Health Policy, Harvard
University Medical School; and br. James B. Wyngaarden, Director,
National Institutes of Health. Their willing and generous guidance
and encouragement at pivotal points in this project enabled us to fine
a direction through a tangle of complex questions and ideas.
Drs. Steven C. Beering, President, Purdue University, David
Satcher, President, Meharry Medical College, Moshe Prywes, Dean
Emeritus, University Center for Health Sciences, Ben Gurion University
of the Negev, and Lechaim Naggan, Dean, University Center for health
Sciences, Ben Gurion University of the ~egev, made it possible for us
to gain a first-hand appreciation of some of the problems that medical
educators face and of the dedication, courage and creative talents
that can forge idealistic yet practical solutions. Their
contributions to the study were invaluable and their warmth and
hospitality to committee and staff will not be forgotten.
Dr. Frederick C. bobbins, President, Institute of Medicine, was
the inspiration and driving force for the entire enterprise--we thank
him for his unfailing interest and support.
Nancy Ahern, Dr. Jane Takeuchi, Jessica Townsend, and Sunny Yoder
made key contributions in the preparation of background papers and
throughout the course of the study, especially in thinking through
issues in need of further study.
Allyn hortimer and Nina Smith were our able researchers and
librarians. We are grateful to Cindy Howe and Nina Smith for their
dedication and capable support and thank Linda DePugh for cheerfully
assisting them in every crunch.
We also are indebted to many persons and organizations too
numerous to name here, for providing information and advice.
Finally, we would have accomplished nothing without the study
director, Dr. Barbara Filner. Her contributions to this
effort--substantively, logistically, and in every other way, were
immeasurable.
Elena (J. Nightingale
Vice-Chairman,
for the Committee
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